A collective sigh of relief came across the country last week. Was it the rebounding stock market? The avoidance of disaster from Irene? Or the fact that Kim Kardashian is finally married? Alas, no. Parents everywhere are rejoicing that school has started. And with one less thing to stress and worry about, everyone should now have clear skin.
"What do you mean, Doc?" you may say. "Stress can affect skin?" You betcha!
When we're stressed, our bodies produce more of a hormone called cortisol. We need that hormone in stressful situations- if we're in danger, about to be attacked, our body responds by saying "run! escape!" and that cortisol kicks us into high gear. But when constant low levels of cortisol are released, it is not a good thing.
Stress can:
increase hair loss
make psoriasis worse
flare acne and rosacea
cause hives
precipitate a shingles outbreak
bring out cold sores
weaken the immune system, making it harder to fight infections
worsen eczema
lead to picking and pulling of skin/nails/hair
But there are ways to manage stress in our lives. Exercising daily and eating a well balanced diet full of fruits, vegetables, and whole grains combats fatigue and stress, and increases energy levels. Yoga, breathing exercises, and a few minutes of mediation daily help to lower cortisol levels. Limiting alcohol and not smoking are important to keeping a healthy glow to the skin. Spending time with family, friends, and pets builds connections and a strong emotional support system. Hobbies, like gardening, or painting, are soothing and calming. Find something you enjoy and look forward to, and make time for it.
As a mom, wife, daughter, friend, sister, and physician, I know how hard it is to try to balance it all. It's important to take a moment for yourself and create calm in your day. Stress is impossible to avoid all together - but reducing and managing it is key for a healthy mind, body, and complexion!
Wednesday, August 31, 2011
Thursday, August 25, 2011
the dreaded "i" word
Recently, I saw a little boy for a rash on his face. His mother, impeccably dressed and coiffed, turned to me and said, "Doctor, is it-" she paused, looked around to make sure no one was around, and continued in a hushed voice, "impetigo?!" Her eyes were filled with horror.
Oh, the dreaded "i" word. It strikes fear in the hearts of parents everywhere, who know that their child will swiftly be sent home from school/daycare/camp/etc if those contagious honey crusts show up on their little angel's face. Okay, so maybe that's a little bit of a dramatization...
What is impetigo? It's a superficial infection of the skin caused primarily by two types of bacteria: staphylococcus aureus, streptococcus pyogenes, or both. It tends to affect preschool children and young adults. Usually it starts as red areas on the skin that become little blisters filled with fluid, which then burst and dry as golden, honey yellow crusts. Sometimes kids can have fever and enlarged lymph nodes, but more often, they feel fine. Often the face is involved, but arms, legs, buttocks, fingertips, and toes can be involved as well.
Why does this happen? These two bacteria can live on the skin and in the nostrils of the patient and/or the patient's family members. The bacteria then overgrow in certain areas of the skin, causing the rash and blisters.
A dermatologist will usually culture the skin or the nose or throat, and will treat with both topical and oral antibiotics. All the family members should be treated as well, because they may be carriers of the bacteria. Since impetigo tends to recur, prevention with antibacterial washes can help, too. Treatment with antibiotics is almost always sufficient. In very rare of strep impetigo, kidney infections or scarlet fever can occur, so it's important to see a dermatologist or pediatrician for treatment.
Junior did not have impetigo. For now, at least...
Oh, the dreaded "i" word. It strikes fear in the hearts of parents everywhere, who know that their child will swiftly be sent home from school/daycare/camp/etc if those contagious honey crusts show up on their little angel's face. Okay, so maybe that's a little bit of a dramatization...
What is impetigo? It's a superficial infection of the skin caused primarily by two types of bacteria: staphylococcus aureus, streptococcus pyogenes, or both. It tends to affect preschool children and young adults. Usually it starts as red areas on the skin that become little blisters filled with fluid, which then burst and dry as golden, honey yellow crusts. Sometimes kids can have fever and enlarged lymph nodes, but more often, they feel fine. Often the face is involved, but arms, legs, buttocks, fingertips, and toes can be involved as well.
Why does this happen? These two bacteria can live on the skin and in the nostrils of the patient and/or the patient's family members. The bacteria then overgrow in certain areas of the skin, causing the rash and blisters.
A dermatologist will usually culture the skin or the nose or throat, and will treat with both topical and oral antibiotics. All the family members should be treated as well, because they may be carriers of the bacteria. Since impetigo tends to recur, prevention with antibacterial washes can help, too. Treatment with antibiotics is almost always sufficient. In very rare of strep impetigo, kidney infections or scarlet fever can occur, so it's important to see a dermatologist or pediatrician for treatment.
Junior did not have impetigo. For now, at least...
Tuesday, August 23, 2011
the pimple that's not a pimple
It seems like a pimple on the nose. Only it's been there for 3 months. And sometimes it bleeds. And when squeezed, nothing seems to come out of it. What's up with this wierd pimple?
This "pimple" has a funny name. It's called basal cell carcinoma. And it's not a pimple; it's a skin cancer. The most common type of skin cancer, in fact. According to the Skin Cancer Foundation, an estimated 2.8 million are diagnosed annually in the US (check out http://www.skincancer.org/Skin-Cancer-Facts/ for some great info). It tends to show up on sun exposed areas, like the nose, ears, and chest. Although it almost always is limited to the skin, basal cell carcinoma can be locally destructive if not treated.
Depending on the type and location of the basal cell carcinoma, different treatment options can be used. Superficial basal cells may be treated with a cream called imiquimod that is applied 5 times a week for 6 weeks. Or, a scraping procedure called electrodessication and curettage (ed&c) can be performed in the dermatologist's office. Larger or infiltrative basal cells can be excised in the office under local anesthesia by the dermatologist. Very large basal cells, or ones located on the nose, lips, ears, or close to the eyes, where there is not a lot of tissue available, may be removed by the Mohs procedure. This is a special type of skin cancer surgery where tissue is removed and checked under the microscope while the patient is still in the office. Once the Mohs surgeon has determined that all the skin cancer has been removed, the area is stitched up. Mohs surgery has a very high cure rate. Usually dermatologists who perform this procedure have an additional year of training after residency to become experts in Mohs.
Once someone has had one basal cell carcinoma, they are 50% more likely to develop a second one. As this type of skin cancer is directly related to sun exposure, protecting your skin from the sun is a great way to prevent their development. Proper sunscreen use of a broad spectrum UVA/UVB sunblock is essential. Clothing, such as hats and shirts, that are specially treated to have a UPF (ultraviolet protection factor) of 50+ can really help protect your skin from the sun. See my recent interview on NBC6 on sunprotective clothing on our website, www.southbeachdermatology.biz for more information.
Any "pimple" that doesn't go away, bleeds, itches, crusts, or grows needs to be seen by a dermatologist to make sure it's not a skin cancer ASAP. Remember, one in five Americans will develop skin cancer in the course of a lifetime. Stay on top of your skin - it's the only one you have!
This "pimple" has a funny name. It's called basal cell carcinoma. And it's not a pimple; it's a skin cancer. The most common type of skin cancer, in fact. According to the Skin Cancer Foundation, an estimated 2.8 million are diagnosed annually in the US (check out http://www.skincancer.org/Skin-Cancer-Facts/ for some great info). It tends to show up on sun exposed areas, like the nose, ears, and chest. Although it almost always is limited to the skin, basal cell carcinoma can be locally destructive if not treated.
Depending on the type and location of the basal cell carcinoma, different treatment options can be used. Superficial basal cells may be treated with a cream called imiquimod that is applied 5 times a week for 6 weeks. Or, a scraping procedure called electrodessication and curettage (ed&c) can be performed in the dermatologist's office. Larger or infiltrative basal cells can be excised in the office under local anesthesia by the dermatologist. Very large basal cells, or ones located on the nose, lips, ears, or close to the eyes, where there is not a lot of tissue available, may be removed by the Mohs procedure. This is a special type of skin cancer surgery where tissue is removed and checked under the microscope while the patient is still in the office. Once the Mohs surgeon has determined that all the skin cancer has been removed, the area is stitched up. Mohs surgery has a very high cure rate. Usually dermatologists who perform this procedure have an additional year of training after residency to become experts in Mohs.
Once someone has had one basal cell carcinoma, they are 50% more likely to develop a second one. As this type of skin cancer is directly related to sun exposure, protecting your skin from the sun is a great way to prevent their development. Proper sunscreen use of a broad spectrum UVA/UVB sunblock is essential. Clothing, such as hats and shirts, that are specially treated to have a UPF (ultraviolet protection factor) of 50+ can really help protect your skin from the sun. See my recent interview on NBC6 on sunprotective clothing on our website, www.southbeachdermatology.biz for more information.
Any "pimple" that doesn't go away, bleeds, itches, crusts, or grows needs to be seen by a dermatologist to make sure it's not a skin cancer ASAP. Remember, one in five Americans will develop skin cancer in the course of a lifetime. Stay on top of your skin - it's the only one you have!
Tuesday, August 16, 2011
Wrinkles and lines and creams?! - oh my!
Some new things are happening, and it's nothing to furrow your brows at. A novel fighter in the war against forehead wrinkles is about to come on the market. And studies are promising for a topical (read: CREAM) to treat forehead wrinkles.
There's Botox, there's Dysport, and now there's... Xeomin. It was approved by the FDA in July 2010 for the treatment of blepharospasm (eyelid spasm) and cervical dystonia, but hasn't received the approval for cosmetic use just yet. One of the main differences between Xeomin and the other two neurotoxins is that it's a "naked" toxin. This means it doesn't have any stabilizing proteins around the toxin molecule. Does this matter? Maybe, maybe not. On one hand, the less proteins, the less chance a person will develop antibodies that may make the treatment less effective. On the other hand, studies have shown that once the powder that the toxin comes in is mixed with saline to form a liquid, 85% of the proteins separate from the toxin (before it is even injected into the patient).
But this is America, and competition is always good. Once Xeomin receives it's cosmetic FDA approval, it will be a welcome addition to our tool box. But what about people that don't want injections? Is there an option for them, too?
Currently, phase 2 trials are being conducted where a neurotoxin gel called Revance is being applied to crow's feet, and the results are promising. In one of the studies, results lasted for 115 days. The current plan is for the gel to be applied in doctor's offices.
The great thing about medicine is that it's constantly changing. New products, new procedures, and new techniques are always emerging. We're getting closer and closer to outsmarting aging.
There's Botox, there's Dysport, and now there's... Xeomin. It was approved by the FDA in July 2010 for the treatment of blepharospasm (eyelid spasm) and cervical dystonia, but hasn't received the approval for cosmetic use just yet. One of the main differences between Xeomin and the other two neurotoxins is that it's a "naked" toxin. This means it doesn't have any stabilizing proteins around the toxin molecule. Does this matter? Maybe, maybe not. On one hand, the less proteins, the less chance a person will develop antibodies that may make the treatment less effective. On the other hand, studies have shown that once the powder that the toxin comes in is mixed with saline to form a liquid, 85% of the proteins separate from the toxin (before it is even injected into the patient).
But this is America, and competition is always good. Once Xeomin receives it's cosmetic FDA approval, it will be a welcome addition to our tool box. But what about people that don't want injections? Is there an option for them, too?
Currently, phase 2 trials are being conducted where a neurotoxin gel called Revance is being applied to crow's feet, and the results are promising. In one of the studies, results lasted for 115 days. The current plan is for the gel to be applied in doctor's offices.
The great thing about medicine is that it's constantly changing. New products, new procedures, and new techniques are always emerging. We're getting closer and closer to outsmarting aging.
Tuesday, August 9, 2011
Ain't Nothing Rosy About It
"Are you hot? Or embarrassed? Why are your cheeks all red?" If you're one of the millions of Americans suffering from rosacea, answering these questions can be a daily annoyance. So let's set the record straight and get to the nitty gritty.
Rosacea is a chronic, inflammatory disease that usually affects the face, and sometimes the eyes. Chronic; meaning there is no cure, but there are many treatments that can help control the disease, which I'll discuss in a minute. Inflammatory; meaning the skin is overactive and sensitive, and has lots of white blood cells around oil glands and hair follicles, and dilated blood vessels. Think of it acne's older cousin.
The condition can look different in each individual. Some people have increased blood vessels on the nose and cheeks which makes them look red and flushed. Others may have acne-like lesions: pimples and pustules. More severe cases can have thickened tissue on the nose, making it look bulbous (think W.C. Fields). It can affect the eyes, making them red, dry and feel "grainy." A combination of all or none of the above can be present.
We don't know exactly what causes it. Genetics may play a role. A mite called Demodex folliculorum (that lives on our skin normally) may play a role. It is clear, however, that certain factors may make it worse, although these also vary from person to person. Alcohol, spicy foods, heat, stress, and sun exposure all can aggravate rosacea.
Luckily, a lot of treatments are available. Oral antibiotics, especially tetracyclines, can help to decrease inflammation and calm bumps. Topical antibiotic creams, azelaic acid creams, sulfur washes/creams are all often prescribed. Lasers, like the intense pulsed light, can zap blood vessels and help reduce redness. In severe cases, accutane and surgery may be used. In all cases, sunscreen and sun avoidance should be part of a daily regimen.
So get friendly with your favorite dermatologist, and put an end to those irritating questions.
Rosacea is a chronic, inflammatory disease that usually affects the face, and sometimes the eyes. Chronic; meaning there is no cure, but there are many treatments that can help control the disease, which I'll discuss in a minute. Inflammatory; meaning the skin is overactive and sensitive, and has lots of white blood cells around oil glands and hair follicles, and dilated blood vessels. Think of it acne's older cousin.
The condition can look different in each individual. Some people have increased blood vessels on the nose and cheeks which makes them look red and flushed. Others may have acne-like lesions: pimples and pustules. More severe cases can have thickened tissue on the nose, making it look bulbous (think W.C. Fields). It can affect the eyes, making them red, dry and feel "grainy." A combination of all or none of the above can be present.
We don't know exactly what causes it. Genetics may play a role. A mite called Demodex folliculorum (that lives on our skin normally) may play a role. It is clear, however, that certain factors may make it worse, although these also vary from person to person. Alcohol, spicy foods, heat, stress, and sun exposure all can aggravate rosacea.
Luckily, a lot of treatments are available. Oral antibiotics, especially tetracyclines, can help to decrease inflammation and calm bumps. Topical antibiotic creams, azelaic acid creams, sulfur washes/creams are all often prescribed. Lasers, like the intense pulsed light, can zap blood vessels and help reduce redness. In severe cases, accutane and surgery may be used. In all cases, sunscreen and sun avoidance should be part of a daily regimen.
So get friendly with your favorite dermatologist, and put an end to those irritating questions.
Monday, August 8, 2011
Zits and wrinkles?!
Just as the Botox starts wearing off on your forehead and the wrinkles return, you also notice you've broken out in three huge zits on your face. Wrinkles and acne? Weren't you supposed to outgrow those pimples? What gives?
The fact remains that age has little to do with it. A lot of factors are involved in acne. One of the key players in women is hormones. Maybe you've noticed you tend to flare right before your menstual cycle starts, and then pimples clear once it's over. Levels of androgens, a type of hormone, fluctuate during the month. They stimulate the sebaceous glands in our skin to produce excess oil and sebum, which contribute to the formation of blocked pores and pimples. Some women also experience irregular menstrual cycles, hirsutism (excess hair growth), and weight gain in addition to acne. Such symptoms may be due to a condition called PCOS, or polycystic ovarian syndrome. This diagnosis can be made by your dermatologist or ob/gyn by checking blood tests, and sometimes an ultrasound.
There are treatments available to help decrease levels of androgens and regulate menstrual cycles, which can often help improve acne. Oral contraceptive pills (birth control) and an anti-androgen medication called spironolactone are often used. Oral antibiotics, and prescription topical medications: antibiotics, benzoyl peroxide, and retinoids can dramatically improve skin. Finally, accutane is a very effective medication for severe acne that does not respond to other treatments.
What about diet and acne? There's been a lot of discussion about dairy, sugar, and chocolate, and their effects on acne. Although there is nothing conclusive, and more studies are needed, it makes sense that certain foods that can increase inflammation in the body. The "white" foods: white sugar, white rice, white bread, potatos, etc are nutritionally empty foods and raise sugar and insulin levels, leading to increased inflammation, which may be harmful to cell health. Eating a balanced diet rich in whole grains, vegetables, and fruit, with a limited amount of animal fats and sugary foods, is a good idea in general. Foods rich in antioxidants, like berries, oranges, pomegranates, salmon, dark chocolate, red grapes, and greens help keep the skin looking healthy. So while dairy is an important source of vitamin D and calcium for women, lowfat greek yogurt is a better choice an a vanilla milkshake (sorry!).
Makeup and products can often be the culprit in breakouts, as well. Look for makeup that is labeled "noncomedogenic," meaning it won't clog pores. Oily sheens for hair can often add to breakout along the forehead. Use mild, gentle cleansers and avoid harsh, abraisive scrubs.
So, there are lots of factors to blame acne on. Thankfully, there are lot of solutions, too.
The fact remains that age has little to do with it. A lot of factors are involved in acne. One of the key players in women is hormones. Maybe you've noticed you tend to flare right before your menstual cycle starts, and then pimples clear once it's over. Levels of androgens, a type of hormone, fluctuate during the month. They stimulate the sebaceous glands in our skin to produce excess oil and sebum, which contribute to the formation of blocked pores and pimples. Some women also experience irregular menstrual cycles, hirsutism (excess hair growth), and weight gain in addition to acne. Such symptoms may be due to a condition called PCOS, or polycystic ovarian syndrome. This diagnosis can be made by your dermatologist or ob/gyn by checking blood tests, and sometimes an ultrasound.
There are treatments available to help decrease levels of androgens and regulate menstrual cycles, which can often help improve acne. Oral contraceptive pills (birth control) and an anti-androgen medication called spironolactone are often used. Oral antibiotics, and prescription topical medications: antibiotics, benzoyl peroxide, and retinoids can dramatically improve skin. Finally, accutane is a very effective medication for severe acne that does not respond to other treatments.
What about diet and acne? There's been a lot of discussion about dairy, sugar, and chocolate, and their effects on acne. Although there is nothing conclusive, and more studies are needed, it makes sense that certain foods that can increase inflammation in the body. The "white" foods: white sugar, white rice, white bread, potatos, etc are nutritionally empty foods and raise sugar and insulin levels, leading to increased inflammation, which may be harmful to cell health. Eating a balanced diet rich in whole grains, vegetables, and fruit, with a limited amount of animal fats and sugary foods, is a good idea in general. Foods rich in antioxidants, like berries, oranges, pomegranates, salmon, dark chocolate, red grapes, and greens help keep the skin looking healthy. So while dairy is an important source of vitamin D and calcium for women, lowfat greek yogurt is a better choice an a vanilla milkshake (sorry!).
Makeup and products can often be the culprit in breakouts, as well. Look for makeup that is labeled "noncomedogenic," meaning it won't clog pores. Oily sheens for hair can often add to breakout along the forehead. Use mild, gentle cleansers and avoid harsh, abraisive scrubs.
So, there are lots of factors to blame acne on. Thankfully, there are lot of solutions, too.
Wednesday, August 3, 2011
Pretty Boys
I saw an attractive man in his 30's in my office yesterday. After performing his full body skin exam to check his moles, I asked him if there was anything else I could help him with. He pointed to his forehead and said, "Well, I really hate these lines on my forhead." I explained to him that those could easily be improved with either Dysport or Botox. With genuine shock he exclaimed, "Botox?! Isn't that for chicks?"
Actually, no. According to a recent report from the American Society of Plastic Surgeons revealed that men underwent more than 1.1 million cosmetic procedures, including both minimally invasive and surgical procedures, up 2% from 2009. There are many reasons for this increase. First, a practical reason: with the downturn in the economy and recent job losses have forced many to search for new positions, and men want (and maybe need?) to appear younger, fresher, and brighter to stay competitive. And second, men are realizing what their female counterparts have known for years: that small, non-invasive changes, like Botox/Dysport, fillers, peels, and lasers, can make a BIG difference in how you look and feel.
Eating a healthy diet, exercising, safe sun practices, and a great dermatologist: the keys to the fountain of youth for both women and men!
Actually, no. According to a recent report from the American Society of Plastic Surgeons revealed that men underwent more than 1.1 million cosmetic procedures, including both minimally invasive and surgical procedures, up 2% from 2009. There are many reasons for this increase. First, a practical reason: with the downturn in the economy and recent job losses have forced many to search for new positions, and men want (and maybe need?) to appear younger, fresher, and brighter to stay competitive. And second, men are realizing what their female counterparts have known for years: that small, non-invasive changes, like Botox/Dysport, fillers, peels, and lasers, can make a BIG difference in how you look and feel.
Eating a healthy diet, exercising, safe sun practices, and a great dermatologist: the keys to the fountain of youth for both women and men!
Monday, August 1, 2011
Hairy and the Hendersons
South Florida is hot, hot, hot. Down here, it's bikini season year 'round. Short shorts and bikinis are in, extra body hair is not. So what's a girl or guy to do?
There are lots of options for getting rid of excess hair. Shaving, waxing, plucking, electrolysis, and depilatory creams are all means of hair removal. However, they can be time consuming, painful, ineffective, and/or irritating to the skin. Enter laser hair removal.
In laser hair removal, a laser beam of a certain wavelength targets the hair follicle and destroys it. I like to call it permanent hair reduction, rather than permanent hair removal. Hair growth occurs in cycles, (see my last blog post: Those Fabulous Tresses for more information), so multiple laser treatments are needed several weeks apart for best results.
Because the laser targets the hair in the follicle, the treatment won't be effective if the hairs are waxed or plucked prior to treatment. Often, shaving is encouraged the day before the treatment. An anesthetic gel is sometimes applied to the area prior to treatment to ensure minimal discomfort. A cool gel, or a cooling tip on the laser is used to protect the skin. The length of time of the treatment depends on the area being treated: an upper lip takes less time than a bikini area.
Usually, the skin will look red temporarily after the treatment. Some crusting may occur. It is very important to protect skin from the sun prior to and after any laser treatment. Tanned skin is at risk for hyper or hypopigmentation (dark spots or light spots), and it's best to avoid any laser treatment on skin that is tan or recently exposed to the sun. Similarly, darker skin types are at risk for pigment disturbances with laser hair removal. Laser hair removal generally is not effective on blond or white hairs.
These days, lasers for hair removal can be found on every corner. You only have one skin: it's wise to see a board certified physician for the best possible results to leave you smooth and (relatively) hairless!
There are lots of options for getting rid of excess hair. Shaving, waxing, plucking, electrolysis, and depilatory creams are all means of hair removal. However, they can be time consuming, painful, ineffective, and/or irritating to the skin. Enter laser hair removal.
In laser hair removal, a laser beam of a certain wavelength targets the hair follicle and destroys it. I like to call it permanent hair reduction, rather than permanent hair removal. Hair growth occurs in cycles, (see my last blog post: Those Fabulous Tresses for more information), so multiple laser treatments are needed several weeks apart for best results.
Because the laser targets the hair in the follicle, the treatment won't be effective if the hairs are waxed or plucked prior to treatment. Often, shaving is encouraged the day before the treatment. An anesthetic gel is sometimes applied to the area prior to treatment to ensure minimal discomfort. A cool gel, or a cooling tip on the laser is used to protect the skin. The length of time of the treatment depends on the area being treated: an upper lip takes less time than a bikini area.
Usually, the skin will look red temporarily after the treatment. Some crusting may occur. It is very important to protect skin from the sun prior to and after any laser treatment. Tanned skin is at risk for hyper or hypopigmentation (dark spots or light spots), and it's best to avoid any laser treatment on skin that is tan or recently exposed to the sun. Similarly, darker skin types are at risk for pigment disturbances with laser hair removal. Laser hair removal generally is not effective on blond or white hairs.
These days, lasers for hair removal can be found on every corner. You only have one skin: it's wise to see a board certified physician for the best possible results to leave you smooth and (relatively) hairless!
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